AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8965/161
1 Sidi Mohamed Ben Abdellah University, Department of Gynécology and Obstetrics II, HASSAN II university hospital of Fez.
2 Sidi Mohamed Ben Abdellah University, laboratory of epidémiology and clinical research.
*Corresponding Author: Alpha Boubacar Conté, Sidi Mohamed Ben Abdellah University, Department of Gynécology and Obstetrics II, HASSAN II university hospital of Fez Morocco.
Citation: Alpha B. Conte., Sofia Jayi, Moutari S. Hadiza., Bineta J. Diagne., Fdili Aloui EZ., et al (2023), Correlation between ultrasound, hysteroscopy and histology in the exploration of postmenopausal metrorrhagia (about 90 cases). Single Center Study, J. Obstetrics Gynecology and Reproductive Sciences, 7(2); DOI:10.31579/2578-8965/161
Copyright: © 2023, Alpha Boubacar Conté. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 04 April 2023 | Accepted: 14 April 2023 | Published: 21 April 2023
Keywords: menopause; metrorrhagia; ultrasound; hysteroscopy; histology
Introduction
Postmenopausal metrorrhagia (PMMs) is a common reason for consultation in gynaecology. It may reveal, during exploration, a benign or malignant pathology that must be differentiated following a para-clinical assessment with the main pathology to eliminate being endometrial cancer. The goal of our study was to assess the correlation between ultrasound, hysteroscopy and histology in the exploration of endo-cavitary lesions when faced with PMMs.
Materials and methods:
This is a retrospective descriptive and analytic study, based on 90 patients treated for postmenopausal metrorrhagia (PMM) in the department of Gynaecology and Obstetrics II of HASSAN II teaching hospital of FES, from January 2014 to January 2017.
Results: The mean age of the patients was 59 years. The correlation of the ultrasound and hysteroscopy data showed that the ultrasound presented sensitivity, specificity, PPV and NPV equal to 100% for endometrial atrophy. For hypertrophy, these values were respectively 74%, 95%, 88%, 87.5%. For the suspicion of cancer, the sensitivity was 100%, the specificity of 98.6%, the PPV of 93% and the NPV of 96%. As for the correlation between hysteroscopy-histology on biopsy, sensitivity, specificity, PPV and NPV were respectively 96.7%, 98.3%, 96.7% and 98.3% for hyperplasia and 94%, 100%, 100% and 98.6% for suspected cancer. The hysteroscopy-histology correlation on the surgical specimen showed 100% sensitivity, specificity, PPV and NPV for polyps and leiomyomas, respectively 96%, 92%, 83.8% and 98.3% for hyperplasia’s and values of 72%, 100%, 100% and 92% for suspected cancer. The degree of performance of each means of exploration was variable according to the lesion in question of the metrorrhagia and generally, the hysteroscopy was more reliable in the exploration of the MMPs than the ultrasound: Kappa of 0.74 against 0.50.
Conclusion: Our results are consistent with the data in the literature, which attributes to hysteroscopy having a greater reliability compared to a pelvic ultrasound in the diagnosis of endo-cavitary lesions as the origin of postmenopausal metrorrhagia. An Ultrasound is the first-line examination in the exploration of PMMs, it should be coupled with diagnostic hysteroscopy and biopsy for better diagnostic accuracy.
Postmenopausal metrorrhagia (MPM) is a frequent reason for consultation and also the main warning signal for endometrial cancer. 70% of gynaecological consultations during peri or post menopause are linked to bleeding [1].
Explorations can reveal benign or malignant pathologies and the methods available to assess endometrial lesions have evolved in recent years. Transvaginal ultrasound (coupled with colour Doppler) is accessible, non-invasive and has become the gold standard in cases of MPM as part of an initial exploration, given the risk of endometrial cancer. The field of investigation has expanded in particular with the development of hysteroscopy.
The objective of our study was to evaluate the correlation between the results of ultrasound, hysteroscopy and histology in the exploration of these MPM, by evaluating for each its feasibility, sensitivity, specificity in the detection endocavitary lesions.
This is a retrospective study describing and analysing over a 3year period (from January 2014 to January 2017), 90 cases of MPM treated in the Gynaecology Obstetrics II department at the UTH Hassan II in Fez.
We defined postmenopausal metrorrhagia as any abnormal uterine bleeding occurring in a woman who had not seen menstrual blood flow for at least 12 consecutive months.
The data was collected from department registers, clinical records, operating reports and the results of the anatomopathological study.
The analysis of the results was made using the IBM SPSS version 20 software. All the quantitative variables were expressed in the form of means and their standard deviation and all the categorical variables in the form of frequency. Then, a univariate analysis was done looking for sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and concordance. The Kappa test was used to measure the concordance between 2 independent judgments on the same endocavitary lesions. We agreed that the concordance is good if Kappa > 0.6, bad if Kappa < 0>
I- Descriptive study
Epidemiology and clinical manifestation:
MPMs represent 62% of hospitalisations among postmenopausal women in the department. The average age of the patients was 59 years ± 8.148 years [47 to 92 years]. 53.4% were between 47 and 59 years old and 35.5Percentage between 60 and 69 years old.
Isolated MPMs represented the most frequent reason for consultation with a proportion of 82.20% followed by MPMs associated with pelvic pain (7.80%) and MPMs associated with leucorrhoea (5.60%). The association of pelvic pain – leucorrhoea and abdominopelvic mass represented respectively 2.20% of the reasons for consultation.
More than half of our patients had moderate obesity (57%) and 39% were overweight. The most documented medical history was hypertension in 21.10% of cases followed by Type 2 diabetes in 12.20% of cases. Hormone replacement therapy (HRT) was observed in one patient and tamoxifen treatment in 2 patients. Nulliparity was observed in 19% of cases. The average age of onset of menopause was 49.9 years ± 4.3 years (36-62 years); 3% had had an early menopause (< 40> 55 years old).
Ultrasound results:
This examination revealed endometrial hypertrophy with a thickness greater than 5 mm in 70 patients (78%), endometrial atrophy with endometrial thickness less than 5 mm in 15.5% of cases and myomas in 6.6% of cases.
The Doppler study was only specified in 4 patients among those who had an appearance with suspicion of malignancy. In these patients, neovascularization of the endometrium has been reported but without studies of the uterine artery.
Results of hysteroscopy:
Several lesions were sometimes found in the same patient. Certain procedures have been associated with hysteroscopy such as: endometrial biopsy (in 98.8% of cases), cervical biopsy in 13% of cases. The main lesions found were endometrial hypertrophy, polyps, suspected cancer, endometrial atrophy and uterine myomas with respective proportions of 34.4%, 22.2, 17.7, 15.5% and 8.8%.
Pathology: biopsy and surgical specimen
Biopsy histology revealed 15 cases of cancer (including 10 endometrioid adenocarcinomas, 2 cervical cancers and 3 other types).
The 28 cases of polyp and myomas found at hysteroscopy were resected by surgical hysteroscopy and the anatomopathological results confirmed their nature.
43.3% of the patients (39) underwent a surgical hysterectomy (HST) for therapeutic purposes and 11% underwent a diagnostic HST. The pathological results on surgical specimens are as follows: polyps (25.9%), hyperplasia with atypia (22%), endometrioid adenocarcinoma (19.4%), hyperplasia without atypia (12.9%), leiomyomas (10.9 %), cancers of the cervix (2.5%) and other types of cancers (6.4%).
Analytical study
Performance study between hysteroscopy and histology on the surgical specimen (Table 1).
The hysteroscopy-histology correlation on the surgical specimen was variable according to the aetiologies, with a good performance for the majority of the lesions.
Table 2: Correlation between ultrasound and hysteroscopy
The correlation between ultrasound and hysteroscopy found a medium concordance with a Kappa of 0.50, so there is a medium concordance.
Table 3: Correlation between hysteroscopy and biopsy histology
The agreement between the results of hysteroscopy and histology on biopsy was good with a kappa value equal to 0.68.
Correlation between hysteroscopy and histology on surgical specimen (Table 4)
Table 4: Correlation between hysteroscopy and histology on surgical specimen
We noted a good correlation between the results of the hysteroscopy and the histology on the operating specimen with a Kappa value equal to 0.74.
In the exploration of the uterus and its annexes in the event of uterine bleeding, ultrasound is an essential first-line examination. Its contribution to diagnostic research is widely demonstrated in the literature.
In post menopause, an ultrasound is considered normal when the endometrium is thin with an endometrial thickness of less than 5 mm in a woman without hormone replacement therapy (HRT) and less than 8 mm in a woman on HRT. Hypertrophy when the thickness of the endometrium is greater than or equal to 5mm in a woman without HRT and greater than 8mm in a woman on HRT [2-4]. The thresholds considered in our study for the diagnoses are similar to those used by these authors. Ultrasounds also makes it possible to visualize the signs of malignancy such as hypervascularization, myometrial invasion.
Okaro E and Bourne T [5], report that regardless of whether HRT is taken or not, considering a threshold greater than 4mm for abnormal endometrium makes it possible to detect 96% of endometrial cancers, and 92% of pathologies endometrial (hyperplasia, polyps), with respective false positives of 39 and 19%, while in two other studies conducted by Dorum A et al, [6] and Gupta JK et al [7], the authors explain that, used alone, this threshold value is not sufficient to exclude endometrial pathology. For the latter, ultrasound alone cannot replace histological examination in the evaluation of the endometrium in the event of postmenopausal metrorrhagia. Because of habit, we resort to other examinations as soon as abnormalities are detected on the ultrasound or when we find a discrepancy between the clinical picture of the patient and the results found on the ultrasound.
One study [8] reported a small proportion (0.1 to 1%) of cases of endometrial cancer with endometrial thickness less than or equal to 4mm. Despite this observation made by the authors of this study [8], other authors consider that additional examinations are not necessary in case of thickness less than 5 mm [9,10]. We also consider that there is no need to resort to further investigations when the thickness of the endometrium is less than 5 mm because in our study, we did not find any malignant pathology for thicknesses of the endometrium. endometrium less than 5 mm.
Correlation ultrasound and hysteroscopy and histology.
Hysteroscopy (HSC) is the examination of choice for exploring endocavitary lesions suspected on ultrasound or in the absence of individualized lesions by ultrasound [11]. It makes it possible to better visualize the signs of atypia such as anarchic vascularisation, the aspects in candle spots and thus to direct the biopsies.
The comparison of the different results observed on ultrasound and hysteroscopy allows us to say that these 2 explorations are 100% concordant for the diagnosis of atrophy.
On the other hand, among the 26 cases of hypertrophy found on ultrasound, only 23 were confirmed by hysteroscopy and 3 lesions were found to be suspicious of malignancy with a concordance of 74%. This could be explained by the fact that the study of the Doppler ultrasound of the endometrium and the uterine artery in search of signs of malignancy had not been done systematically.
The ultrasound had objectified 14 suspicious images among which 13 were confirmed by the hysteroscopy since in one woman the hysteroscopy could not be done which gives us a concordance of 100%.
Among the 28 cases of hypertrophy associated with a suspected polyp objectified on ultrasound, 20 cases of polyps were confirmed on hysteroscopy and the 8 other cases had returned in favor of polyploid hypertrophy plus candle spots and this with 75
We separately studied the sensitivity, specificity, positive and negative predictive values of pelvic ultrasound and hysteroscopy in the exploration of postmenopausal metrorrhagia. The degree of performance of each means of exploration varied according to the lesion in question of metrorrhagia and in general hysteroscopy (Kappa 0.74) was more reliable in the exploration of metrorrhagia than ultrasound (Kappa 0.50). We believe that hysteroscopy may not be performed during the first episodes of MPM if the ultrasound shows endometrial atrophy, but it is important that the ultrasound is performed or supervised by an experienced operator. For endometrial hypertrophy, ultrasound must always be supplemented by Doppler in search of endometrial neovascularization plus the study of the uterine artery, which would improve the concordance between ultrasound and hysteroscopy in the diagnosis of aspects of atypia. Hysteroscopy should be performed whenever ultrasound finds an abnormality, outside of atrophy.
Conflicts of interest: No conflict of interest between the different authors.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
